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Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease: findings from the Multi-Ethnic Study of Atherosclerosis

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Authors
Jackson, Chandra L
Umesi, Chizoba
Gaston, Symielle A
Azarbarzin, Ali
Lunyera, Joseph
McGrath, John A
Jackson Ii, W Braxton
Diamantidis, Clarissa J
Boulware, Ebony
Lutsey, Pamela L
Redline, Susan
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Abstract
<jats:sec><jats:title>Background</jats:title><jats:p>Poor sleep may contribute to chronic kidney disease (CKD) through several pathways, including hypoxia-induced systemic and intraglomerular pressure, inflammation, oxidative stress and endothelial dysfunction. However, few studies have investigated the association between multiple objectively measured sleep dimensions and CKD.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We investigated the cross-sectional association between sleep dimensions and CKD among 1895 Multi-Ethnic Study of Atherosclerosis Sleep Ancillary Study participants who completed in-home polysomnography, wrist actigraphy and a sleep questionnaire. Using Poisson regression models with robust variance, we estimated separate prevalence ratios (PR) and 95% CIs for moderate-to-severe CKD (glomerular filtration rate &lt;60 mL/min/1.73 m<jats:sup>2</jats:sup> or albuminuria &gt;30 mg/g) among participants according to multiple sleep dimensions, including very short (≤5 hours) sleep, Apnoea−Hypopnoea Index and sleep apnoea-specific hypoxic burden (SASHB) (total area under the respiratory event-related desaturation curve divided by total sleep duration, %min/hour)). Regression models were adjusted for sociodemographic characteristics, health behaviours and clinical characteristics.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of the 1895 participants, mean age was 68.2±9.1 years, 54% were women, 37% were white, 28% black, 24% Hispanic/Latino and 11% Asian. Several sleep metrics were associated with higher adjusted PR of moderate-to-severe CKD: very short versus recommended sleep duration (PR=1.40, 95% CI 1.06 to 1.83); SASHB (Box-Cox transformed SASHB: PR=1.06, 95% CI 1.02 to 1.12); and for participants in the highest quintile of SASHB plus sleep apnoea: PR=1.28, 95% CI 1.01 to 1.63.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Sleep apnoea associated hypoxia and very short sleep, likely representing independent biological mechanisms, were associated with a higher moderate-to-severe CKD prevalence, which highlights the potential role for novel interventions.</jats:p></jats:sec>
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Journal article
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https://hdl.handle.net/10161/21889
Published Version (Please cite this version)
10.1136/thoraxjnl-2020-214713
Publication Info
Jackson, Chandra L; Umesi, Chizoba; Gaston, Symielle A; Azarbarzin, Ali; Lunyera, Joseph; McGrath, John A; ... Redline, Susan (n.d.). Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease: findings from the Multi-Ethnic Study of Atherosclerosis. Thorax. 10.1136/thoraxjnl-2020-214713. Retrieved from https://hdl.handle.net/10161/21889.
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Scholars@Duke

Boulware

L. Ebony Boulware

Nanaline Duke Distinguished Professor of Medicine
Dr. Boulware directs the Duke Clinical and Translational Science Institute as Vice Dean for Translational Science and Associate Vice Chancellor for Translational Research, and she is Chief of the Duke Division of General Internal Medicine in the Department of Medicine. She is a general internist, physician-scientist and clinical epidemiologist focused on improving health and h
Diamantidis

Clarissa Jonas Diamantidis

Associate Professor of Medicine
Lunyera

Joseph Lunyera

Medical Instructor in the Department of Medicine
I am a clinical epidemiologist with a life-long desire to advance our understanding of etiologic mechanisms of kidney disease, and to advocate for policies that promote the highest quality care for individuals with kidney disease. Specifically, I am interested in delineating mechanisms by which exposures in the social environment perpetuate disparate adverse kidney outcomes such as chronic kidney disease and acute kidney injury.
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